Reporting 99211 for blood draws - Need help !

Reporting 99211 for blood draws - Need help !

When a patient comes in to office solely for a blood draw for labs, or for an immunization, should we report CPT code 99211?

AMA Comment :

The answer to this coding issue will not be the same for every patient. In some instances, the clinician may be performing an Evaluation and Management service (i.e., reviewing patient history, performing patient exam and/or medical decision making) in addition to doing the venipuncture or immunizing the patient. When performed, the Evaluation and Management service (the office visit) may be reported via CPT code 99211 or other E/M service. You should append modifier -25 to the Evaluation and Management service code to indicate that an Evaluation and Management service and a procedure were performed on the same date of service. Conversely, if no Evaluation and Management services are performed, then only report the CPT code for the venipuncture (e.g., 36415) or for the immunization (90700 - 90749). "

Personally I think that means that we are correct in billing 99211 for blood draws if the nurses/phlebotomists are reviewing the charts, which, they routinely do.

Would like to have further thoughts on the same.

Need to know the billing rules for billing 99211. When can you bill this? Can you bill this when the person is here for CBC? Can you bill it when the person is here for lab work or shots? Its appreciated if someone can email me CCI edits on this.

Merely reviewing a chart is not an E&M service. Were vitals done? Was there a medical decision making involved? If it is solely for a blood draw, and the only chart review is to see what you are drawing for, then no, you don't get the E&M.

Per CPT, 99211: Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.

It is the only E/M code that does not require a history, examination or medical decision making. It is mainly used for incident to services.

In Appendix C of your CPT manual, the following are examples of the use of CPT 99211:

Office visit for a 50-year-old male, established patient, for removal of uncomplicated facial sutures. (Plastic Surgery)

Office visit for an established patient who lost prescription for lichen planus. Returned for new copy. (Dermatology)

Office visit for an established patient undergoing orthodontics who complains of a wire which is irritating his/her cheek and asks you to check it. (Oral & Maxillofacial Surgery)

Office visit for a 50-year-old female, established patient, seen for her gold injection by the nurse. (Rheumatology)

Office visit for a 73-year-old female, established patient, with pernicious anemia for weekly B12 injection. (Gastroenterology)

Office visit for an established patient for dressing change on a skin biopsy. (Dermatology)

Office visit for a 19-year-old, established patient, for removal of sutures from a two cm. laceration of forehead, which you placed four days ago in ER. (Plastic Surgery)

Office visit of a 20-year-old female, established patient, who receives an allergy vaccine injection and is observed for a reaction by the nurse. (Otolaryngology, Head & Neck Surgery)

Office visit for a 45-year-old male, established patient, with chronic renal failure for the administration of erythropoietin. (Nephrology)

Office visit for an established patient, a Peace Corps enlistee, who requests documentation that third molars have been removed. (Oral & Maxillofacial Surgery)

Office visit for a 69-year-old female, established patient, for partial removal of antibiotic gauze from an infected wound site. (Plastic Surgery)

Office visit for a 9-year-old, established patient, successfully treated for impetigo, requiring release to return to school. (Dermatology/Pediatrics)

Office visit for an established patient requesting a return-to-work certificate for resolving contact dermatitis. (Dermatology)

Office visit for an established patient who is performing glucose monitoring and wants to check accuracy of machine with lab blood glucose by technician who checks accuracy and function of patient machine. (Endocrinology)

Office visit for 14-year-old, established patient, to re-dress an abrasion. (Orthopaedic Surgery)

Office visit for a 45-year-old female, established patient, for a blood pressure check. (Obstetrics & Gynecology)

Office visit for a 23-year-old, established patient, for instruction in use of peak flow meter. (Allergy & Immunology)

Office visit for prescription refill for a 35-year-old female, established patient, with schizophrenia who is stable but has run out of neuroleptic and is scheduled to be seen in a week. (Psychiatry)

The following is from the American Academy of Family Physicians:

"One word of caution about 99211: You can't bill for the administration of an injectable medication (90782) or for the administration of an immunization (90471, 90472) and a nursing visit at the same time. You can either bill for the 99211 plus the medications or bill for the injection plus the medications. When the nurse must make an evaluation of the patient (e.g., when giving a depo-progesterone shot, the nurse must consider, "might the patient be pregnant?"), then our practice uses the 99211. If the nurse must only give an injection, we use the injection codes."

Q. Is it appropriate to submit 99211 when a patient comes into the office for a blood-pressure check and lab draw?

A. CPT code 99211 is the appropriate code to use for a blood-pressure check, according to the examples listed for 99211 in Appendix C of the CPT manual. Note, however, that when submitting 99211 for a blood-pressure check, it's important to ensure that the check is appropriately ordered and medically necessary; otherwise, payers such as Medicare may deny it as a screening service or determine that it is not "reasonable and necessary." For lab draws, there are specific codes other than 99211 that you can submit (e.g., 36415, "Collection of venous blood by venipuncture" or, for Medicare patients, G0001, "Routine venipuncture for collection of specimen(s)").When a lab draw and a blood-pressure check are performed and documented on the same day, you may submit the appropriate lab-draw code and 99211 with modifier -25 attached to indicate that there was a significant, separately identifiable E/M service performed on the same date as the lab draw. [For more information on the use of 99211, see "Coding Level-One Office Visits: A Refresher Course," July/August 2000, page 39.]